HIV and Aging: Parallels and Synergistic Mechanisms Leading to Premature Disease and Functional Decline

The success of antiretroviral therapy in preventing progression of human immunodeficiency virus (HIV) infection to full-blown Acquired Immune Deficiency Syndrome (AIDS) and extending the life span of people infected with HIV has led to a large number of persons aging with HIV (PAWH). This cohort is experiencing high rates of cardiovascular disease, cancer, and other serious, often chronic illnesses resulting in premature multi-morbidity, polypharmacy and functional decline. It is unclear whether chronic HIV infection, its treatment and associated side effects (e.g. lipodystrophy), or other risk factors prominent in PAWH (e.g. smoking, drug use, social isolation/stress) are responsible for this early onset of disease and functional decline, but there is no doubt that rates of geriatric syndromes like frailty, falls and cognitive impairment occur in 55–60 year old PAWH at a rate equivalent to that seen in 70+ year old HIV-uninfected persons. It is still unclear whether HIV-associated ‘aging’ is truly due to acceleration of the aging process or whether HIV is a risk factor for multiple diseases leading to the “aged phenotype” at a younger age. Uncovering the critical processes which drive age-related changes and identifying therapeutic strategies to ameliorate them will be important for management of PAWH.